How is Cardiac syndrome X / Microvascular Angina diagnosed?

Cardiac syndrome X, also known as microvascular angina, is a condition characterized by chest pain or discomfort that occurs in the absence of significant coronary artery blockages. It primarily affects women and is often associated with abnormalities in the small blood vessels of the heart.

Diagnosing cardiac syndrome X can be challenging as it requires ruling out other potential causes of chest pain and assessing the function of the coronary microcirculation. The diagnostic process typically involves a combination of medical history evaluation, physical examination, and various tests.

Medical history evaluation: The doctor will ask detailed questions about the patient's symptoms, including the nature, frequency, and duration of chest pain. They will also inquire about any risk factors for heart disease, such as smoking, high blood pressure, or diabetes. It is important to provide accurate and detailed information to help guide the diagnostic process.

Physical examination: The doctor will perform a thorough physical examination, including measuring blood pressure, listening to the heart and lungs, and checking for any signs of other underlying conditions. While physical examination alone cannot confirm the diagnosis, it helps in assessing overall health and identifying any additional symptoms or signs.

Electrocardiogram (ECG): An ECG is a non-invasive test that records the electrical activity of the heart. It can help detect any abnormal heart rhythms or signs of previous heart attacks. However, in cardiac syndrome X, the ECG is typically normal or may show non-specific changes.

Stress testing: Stress tests evaluate the heart's response to physical exertion. Exercise stress tests involve walking on a treadmill or riding a stationary bike while the heart's activity is monitored. In some cases, a medication may be used to simulate the effects of exercise. Stress testing helps assess the heart's function and can detect any abnormalities in blood flow to the heart.

Coronary angiography: This invasive procedure involves injecting a contrast dye into the coronary arteries to visualize any blockages or abnormalities. However, in cardiac syndrome X, the coronary angiogram usually appears normal as the condition primarily affects the smaller blood vessels that are not visible on this test.

Coronary microvascular function testing: This specialized test evaluates the function of the small blood vessels in the heart. It can be done using various techniques, such as coronary flow reserve measurement or invasive coronary reactivity testing. These tests assess how well the coronary microcirculation responds to stress or medications and can help confirm the diagnosis of cardiac syndrome X.

It is important to note that the diagnosis of cardiac syndrome X is often one of exclusion, meaning other potential causes of chest pain must be ruled out before reaching this diagnosis. A comprehensive evaluation by a cardiologist is crucial to ensure an accurate diagnosis and appropriate management of the condition.